Amid increasing reports of illnesses among workers helping to clean up oil in the Gulf of Mexico and residents living along the coast, concern is rising about health risks posed by the disaster and cleanup efforts.

"We're very concerned about the impact of the disaster on the public health of people in the gulf region," said Health and Human Services Secretary Kathleen Sebelius as she outlined steps the government was taking to respond to any physical and mental health problems that emerge from the spill.

In a sternly worded letter sent Friday to BP Chairman Lamar McKay, Sebelius urged the company "to take responsibility for the health consequences of the disaster." The Centers for Disease Control and Prevention is monitoring poison centers and the BioSense tracking system for signs of any emerging medical problems, Sebelius said. The Environmental Protection Agency had tested more than 15,000 air samples from Venice, La., to Pensacola, Fla., and had not yet detected dangerous substances at hazardous levels, she said. More than 500 water and soil samples have also been tested, she said.

Nevertheless, the National Disaster Medical System has been activated to provide additional medical care in the five gulf states, and a federal mobile medical unit was being sent to Louisiana to help assess anyone complaining of illness, Sebelius said.

At least nine workers were hospitalized last week, including seven who were taken to the hospital Wednesday after complaining of nausea, dizziness and headaches, prompting the Coast Guard to order all 125 boats working in the Breton Sound area to return to port as a precaution. An investigation was underway to try to determine the cause. Residents living along the coast have been reporting similar symptoms.

Although BP officials and federal authorities have emphasized that all necessary precautions were being taken, questions are being raised by independent scientists, members of Congress and other federal officials, especially for the thousands of workers spending long hours in often overpowering fumes being emitted from the oil.

"There's no way you can be working in that toxic soup without getting exposures," Hugh Kaufman, a senior policy analyst at the EPA's office of solid waste and emergency response, said during an interview Thursday. He likened the response to previous toxic waste disasters and the World Trade Center cleanup, which left workers with long-term respiratory problems despite repeated official claims that workers did not need respirators because the working conditions were safe. "It's unbelievable what's going on. It's like deja vu all over again," he said.

The situation is being complicated by weather conditions, which include severe heat and humidity. That can cause symptoms similar to those triggered by some of the chemicals workers may be exposed to.

Assessing the health risks is also difficult because of several unknowns, including a lack of information about the makeup of chemicals being used to disperse the oil and how those substances might affect the toxicity of the oil, several experts said.

The most worrisome chemicals are volatile organic compounds, such as benzene, which can cause cancer at high levels and in long exposures. But those and other substances in the oil can cause acute symptoms including severe skin irritation, headaches, dizziness, nausea and burning eyes, as well as breathing problems and neurological complications including memory problems, confusion and disorientation.

Most acute symptoms from the chemical exposure disappear after the exposure ends, but long-term complications can occur. Some fishermen involved in cleaning up the Exxon Valdez oil spill in Alaska suffered long-lasting neurological problems.

The National Institute of Environmental Health Sciences designed a safety course in English, Spanish and Vietnamese that all cleanup workers are supposed to complete before they can begin work. They are also supposed to be equipped with protective gear, such as gloves and boots. Nevertheless, reports have emerged of workers doing cleanup in street clothes and with bare hands.

David Michaels, the assistant secretary of labor for occupational safety and health, last week complained in a memo to national incident commander Thad Allen about "significant deficiencies" in BP's handling of the safety of oil spill workers, according to published reports.

The National Institute of Occupational Safety and Health, meanwhile, is gathering information about cleanup workers to track their health and document any problems that might emerge.

The most worrisome substances in the oil that can become airborne are expected to have dissipated by the time most of the oil reaches shore, reducing the risk from dangerous fumes to residents along the coast. But they will still face risks from getting the thicker oil on their skin. And because so much of the oil is traveling underwater, exactly what form it will take when it emerges remains unknown.

Over the long term, the oil could pose a risk to human health by getting into the food chain. The Food and Drug Administration is working with the National Oceanic and Atmospheric Administration to help determine when fishing can safely resume.

"There's going to be a legacy of contamination in the gulf food web," said Gina Solomon, a senior scientist for the Natural Resources Defense Council.

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